Endotracheal tubes are usually placed in the trachea of the patient, the inflatable cuff expanded to seal the trachea with the connector end extending out of the mouth of the patient. The customary method used to secure the endotracheal tube to a patient is to loop white adhesive tape around the head with the ends being wrapped around the tube at the corner of the mouth. The white adhesive tape, of course, becomes quickly soiled by oral secretions, mucus, blood, and perspiration. However, since it is easily available, inexpensive and a method familiar to everyone, it is used in spite of its inherent problems. That is, irritation of the skin, possible tube displacement during tape change, a media for infection and varied methods of application, many of which are inefficient.
There have been several devices designed for holding an endotracheal tube in position and some are on the market but they all have inherent drawbacks. Generally, the present devices are expensive and cumbersome, leading to poor acceptance by the medical community. Further, the tubes tend to slip through the device no matter how tightly it is fastened because of oral secretions, mucus, blood and perspiration accumulating on these devices. These secretions, in addition to providing an excellent media for infection, also provide organic lubricants which can cause the tube to slip. For that reason the white adhesive tape method is still widely used in spite of its inherent problems.
In the clinical placement of all endotracheal tubes, the pilot line for inflating the external cuff is used as a guide for determining the depth that the tube should be placed in the airway. The endotracheal tube is inserted through the mouth until the place where the pilot line exits the side of the endotracheal tube is at the corner of the mouth and is then secured. The pilot line is therefore frequently referred to as an idiot line, as it supposedly is nearly impossible for anyone to insert the tube to an incorrect depth because they can determine the depth by simply checking the position of this line. However, this method of placing the tube is based on the erroneous, but widely accepted, premise that the distance between the mouth and the vocal cords is uniform in all adults, even though this may not be the case.
Also, in present endotracheal tubes, unless the size is noted before insertion, the tube size cannot be determined except through measurement. Since these tubes are often left in place for days or even weeks at a time, it is frequently necessary to replace a tube which has malfunctioned. This can occur in the form of a leak in the tube or a leak in the inflatable cuff, preventing a proper seal in the trachea. Further, it may be necessary to insert a bronchoscope for diagnostic or therapeutic purposes, thereby requiring removal of the tube. For this reason, knowing the tube size is important.
It is therefore one object of the present invention to provide an endotracheal tube retainer which will eliminate these disadvantages and provide a simple, reliable means of securing the endotracheal tube to the patient.
Another object of the present invention is to provide retaining means in the form of integrally formed tabs as part of the endotracheal tube which are not affected by secretions, need no adhesive tape and is simple and inexpensive to use.
Yet another object of the present invention is to provide several pairs of integrally formed tabs which, when not in use, will wrap around and be secured, closely fitting the outside surface of the tube.
Yet another object of the present invention is to provide a plurality of retaining tabs or flaps along a short length of the tube providing a shorter variation in tube depth adjustment, making the device versatile enough for use by any adult.
Still another object of the present invention is to provide retaining tabs or flaps which, when folded tightly against the tube, will allow the endotracheal tube to be used in a conventional manner without utilizing the tab ties for securing.
Still another object of the present invention is to provide indicating means integrally formed on the surface of the surface of the tube which permits immediate identification of tube size.